WHAT YOU NEED to KNOW ABOUT Dispensing Drugs in the Sports Team Setting
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TEAM PHYSICIAN’S CORNER WHAT YOU NEED TO KNOW ABOUT Dispensing Drugs in the Sports Team Setting By Serj Mooradian, Barnes and Thornburg LLP 2 SPORTS MEDICINE UPDATE MARCH/APRIL 2015 n November 16, 2014, the U.S. Drug Enforcement Agency (DEA) interviewed the medical personnel and inspected the medical records KEY POINTS of the San Francisco 49ers, Tampa Bay Buccaneers, and Seattle Seahawks O 1 To dispense or administer a 1 after the three teams played away games in other states. The DEA was drug, a person must be licensed investigating whether the medical personnel were appropriately licensed or otherwise authorized by the to possess and handle prescription drugs in the other states, after a recent state in which the dispensing or administering occurs. class-action lawsuit filed against the NFL by former players included 2 allegations that teams routinely dispensed Percocet, Toradol, Novocain, A prescribing practitioner can personally transport 2 and other drugs to energize players before games and relieve pain afterward. non-controlled-substance prescription drugs, including The DEA raids lead to the question: act or by allowing physicians to delegate across state lines. what authority do the medical personnel such authority to the nurse practitioners 3 Both federal and state of sports teams have to carry and dispense and physician assistants. controlled substance acts drugs while away from home? States may impose procedural impose restrictions on This article gives an overview of the requirements on licensed prescribers who practitioners’ dispensing law concerning dispensing prescription dispense. For example, a state may require controlled substances. drugs in the sports team setting, that licensed prescribers: (a) register 4 A practitioner can only transport including the requirements related to: with either their professional boards or controlled substances between physical locations at which licensure requirements for dispensing the board of pharmacy in their state before they are authorized by their and administering prescription drugs; dispensing or administering; or (b) only DEA and applicable state registration requirements for dispensing and dispense or administer after issuing valid registration numbers to administering controlled substances; general prescription orders. A small number dispense and administer requirements for travelling with prescription of states restrict certain prescribing controlled substances. drugs; and considerations when delivering practitioners from dispensing or 5 An individual does not need over-the-counter (OTC) drugs. administering prescription drugs except in to be licensed to deliver OTC certain circumstances, such as emergencies. medication, but they should work with a licensed prescriber Who Can Dispense and The legal scope of practice of some and OTC drugs should be Administer Prescription Drugs other licensed practitioners, such delivered with federally required in the Sports Team Setting? as registered nurses and pharmacists, packaging and labeling. In most states, a practitioner who is includes dispensing and administering licensed to prescribe drugs is also permitted prescription drugs, but not prescribing to dispense and administer drugs. them. These licensed practitioners prescription drugs and physical therapists For example, physicians receive dispense or administer prescription to administer prescription oxygen. authority to both prescribe and dispense drugs only pursuant to the valid order However, in both cases, licensed prescribers from their states’ medical practice acts, of a licensed prescriber, subject to any must usually provide a valid order for the which usually define the “practice of additional restrictions in their respective drugs and supervise their administration. medicine” to include prescribing, ordering, practice acts. A valid order can be in the If a licensing act permits a practitioner giving, or administering any drug form of: (a) a patient-specific prescription to dispense or administer prescription or medicine. (References in this article order; (b) a standing order authorizing drugs pursuant to a prescription order, to “physicians” refer to both allopathic and dispensing or administration of a drug the licensing act may further permit osteopathic physicians and reference to the to a specific patient; or (c) a non-patient- such practitioner to delegate authority “practice of medicine” or “medical practice specific standing order authorizing to dispense or administer prescription act” apply equally to the “practice of dispensing or administration of a drug drugs to unlicensed assistants under osteopathy” or “osteopathic practice act.”) to an identified population of patients. the practitioner’s supervision. Most states also grant nurse practitioners Some states grant very limited Other unlicensed coaching personnel and physician assistants the power to authority to other non-prescribing not acting under the direction of a prescribe, dispense, and administer some providers to administer prescription drugs. practitioner and pursuant to a valid (but usually not all) prescription drugs, For example, some states permit certified order do not have authority to dispense either directly in the appropriate practice athletic trainers to administer topical or administer any prescription drugs. MARCH/APRIL 2015 SPORTS MEDICINE UPDATE 3 Where Can Sports Team Personnel Dispense and Administer Prescription Drugs? To dispense or administer a drug, a person must be licensed or otherwise authorized by the state in which the dispensing or administering occurs. Accordingly, when a practitioner travels to a state in which the practitioner is not licensed or certified, he or she may only dispense or administer prescription drugs in the destination state if the destination state’s law permits such practitioner to practice the profession without a license or certification. For example, a survey of state medical boards conducted by Viola et al. in 2012 found that seventeen states allow team physicians licensed in other states to practice medicine in the state temporarily. 3 The states permitting such activity are Arkansas, California, Colorado, Connecticut, Delaware, Indiana, Iowa, Kentucky, Minnesota, Mississippi, Montana, New Hampshire, North Carolina, Utah, Virginia, Washington, and Wyoming. 3 Additionally, Missouri grants exceptions to physicians from bordering states. The survey also identified states that allow physicians licensed in other states to consult with in-state physicians for the purpose of treating destination state patients. 3 (Note: Since 2000, Florida has exempted out-of-state licensees travelling with visiting sports teams from Florida’s licensure requirements, if an equivalent license category exists in Florida. Additionally, since the publication of the Viola article, Ohio has passed legislation temporarily exempting sports team physicians from Ohio’s medical licensure requirement. Other states may have passed similar exemptions or may pass similar exemptions in the future.) The same rules apply to non-physician practitioners who have authority to dispense or administer in one state and travel to another in which they are not licensed. The destination state 4 SPORTS MEDICINE UPDATE MARCH/APRIL 2015 must permit the practitioner to dispense or administer prescription drugs in the destination state. With respect to a nurse practitioner or physician assistant who dispenses or administers under delegated authority from a physician, the destination state must authorize both the nurse practitioner or physician assistant, as the case may be, and the delegating physician to practice their respective professions in the destination state without a license. Additional Requirements to Dispense and Administer Controlled Substances The federal and state controlled substances acts impose restrictions on practitioners dispensing controlled substances. Under federal law, a practitioner may only store, dispense, or administer controlled substances at a physical location and address registered with the DEA. Therefore, a practitioner dispensing or administering controlled substances at multiple practice locations must do so at each location under that location’s specific DEA registration number. Most states similarly require practitioners to dispense under a state controlled substances registration. substances. This applies whether the 1. Criminal Liability. The severity DEA and state (where applicable) controlled substances are transported of the potential penalties varies registrations authorize registrants’ within the same state or across state lines. from state to state, but they generally employees and agents to dispense or Additionally, because the transfer consist of a fine and/or imprisonment. administer controlled substances at the affects the inventories of controlled With respect to controlled substances registered locations, if it is within their substances between two registered violations, a practitioner can be legal scope of practice to do so. locations, federal law requires that subject to penalties under state the registrants complete specific DEA and federal law. Transporting Drugs to Be Dispensed order forms (for Schedule II controlled 2. Professional Discipline. Most practice in Another Location substances) or drug-specific invoices acts allow professional boards to Usually, a prescribing practitioner can (for Schedule III-V controlled substances), discipline a licensee for engaging in personally transport non-controlled- as may be applicable,